With the addition of data from 2014, the impact of the Medicaid Expansion is demonstrated in the shift of total cases for Self Pay and Charity to Medicaid. For the types of cases examined, both inpatient and outpatient, this shift is evident.

Acute adult and pediatric cases continue to trend downward. Psychiatric and chemical dependency cases have an overall upward trend, but have experienced three quarters of continued decline. Conversely, physical rehabilitation cases trend slightly up, with increases in cases over the last three quarters.

The trend for outpatient cases with surgical procedures has remained flat. The large drop in the first quarter of 2013 reflects under-reporting by a major provider. Historically, the first quarter of each year has been low, compared to other quarters of data.

Outpatients with emergency services also continue to trend upward, with decline in the last two quarters of data. Medicaid cases (managed care and traditional) grew substantially in the first quarter of 2014, compared to previous quarters of data, off-setting self-pay and charity cases.